Treatment - Anger, Hostility, and Aggression

TREATMENT

The treatment of aggressive clients often focuses on treating the underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar disorder. Successful treatment of comorbid disorders results in successful treatment of aggressive behavior. Lithium has been effective in treating aggressive clients with bipolar disorder, conduct disorders (in children), and mental retardation. Carbamazepine (Tegretol) and valproate (Depakote) are used to treat aggression associated with dementia, psychosis, and per-sonality disorders. Atypical antipsychotic agents such as clozapine (Clozaril), risperidone (Risperdal), and olan-zapine (Zyprexa) have been effective in treating aggressive clients with dementia, brain injury, mental retardation, and personality disorders. Benzodiazepines can reduce irritability and agitation in older adults with dementia, but they can result in the loss of social inhibition for other aggressive clients, thereby increasing rather than reducing their aggression.

Haloperidol (Haldol) and lorazepam (Ativan) are com-monly used in combination to decrease agitation or aggres-sion and psychotic symptoms. Patients who are agitated and aggressive but not psychotic benefit most from loraze-pam which can be given in 2-mg doses, every 45 to 60 minutes (Garlow, Purselle, & D’Orio, 2006). Goedhard and associates (2006) found that atypical antipsychotics were more effective than conventional antipsychotics for aggressive, psychotic clients. Use of antipsychotic medica-tions requires careful assessment for the development of extrapyramidal side effects, which can be quickly treated with benztropine (Cogentin).

Although not a treatment per se, the short-term use of seclusion or restraint may be required during the crisis phase of the aggression cycle to protect the client and oth-ers from injury. Many legal and ethical safeguards govern the use of seclusion and restraint .